Background Metacognitive therapy (MCT; Wells, 2009) is a transdiagnostic alternative to cognitive-behavioural therapy (CBT) for adult depression. Prior meta-analyses reported large effects but combined within- and between-group designs, mixed anxiety and depression samples, and did not apply contemporary small-sample meta-analytic methods. Several large multi-site randomised controlled trials (RCTs) published after 2018 have not been incorporated into a focused, methodologically up-to-date synthesis. Objective This study had two complementary aims: (a) to appraise the existing meta-analytic evidence base on MCT for depression through an umbrella review (with AMSTAR-2 quality appraisal); and (b) to synthesize the efficacy of MCT for adult depression using strictly between-group post-treatment comparisons from RCTs reporting BDI or BDI-II as the primary outcome, applying methods appropriate for small-k meta-analyses. Methods Reporting followed the 2020 PRISMA statement. We searched MEDLINE, PsycINFO, CENTRAL, and Embase through May 2026. Three peer-reviewed meta-analyses or systematic reviews were formally appraised in the umbrella review component; one additional non-peer-reviewed preprint was considered contextually. For the meta-analysis component, six RCTs (N = 641 randomised; 546 contributing to the analyses) met all inclusion criteria. Standardized mean differences (Hedges’ g) at post-treatment were synthesised using a random-effects model with restricted maximum likelihood (REML) estimation and Knapp-Hartung adjustment. We pre-specified moderator analyses for control type, researcher allegiance, and MCT version; conducted formal influence diagnostics (DFFITS, Cook’s distance); and reported a 95% prediction interval alongside the 95% confidence interval. Four sensitivity analyses examined inclusion of additional depression measures, exclusion of model-implied SDs, exclusion of influential observations, and long-term follow-up. Results The umbrella review identified three peer-reviewed meta-analyses or systematic reviews (Normann et al., 2014, Normann and Morina, 2018, Zanini et al., 2024), each with at least one critical methodological limitation (mixing within- and between-group estimates; no prediction interval; no formal allegiance moderator analysis); AMSTAR-2 ratings ranged from low to moderate confidence. The meta-analytic update found that MCT produced a statistically significant reduction in post-treatment depressive symptoms (Hedges’ g = 0.87, 95% CI [0.05, 1.68], p = 0.041). Heterogeneity was considerable (I2 = 89.4%, τ2 = 0.47); the 95% prediction interval [-1.23, 2.96] extended into negative values. Control type explained 61.3% of between-study variance: against passive controls g = 1.42 (k = 3), against active comparators g = 0.41 (k = 3). One trial (Hagen et al., 2017) was identified as a single influential observation (DFFITS = 1.59, Cook’s D = 0.64); its exclusion attenuated the pooled estimate to g = 0.61 (95% CI [0.17, 1.06]). At 6–12 month follow-up, no significant pooled effect was detected (g = 0.56, p = 0.154, k = 4). Formal tests detected no funnel-plot asymmetry, although the statistical power of these tests is low with k = 6 trials. Conclusion The available RCT evidence is consistent with a beneficial effect of MCT for adult depression in the short term, but the magnitude of this effect varies substantially with the comparator, depends heavily on a single influential trial, and is not clearly maintained at follow-up. Independent, adequately powered RCTs using active control comparators are needed.
College students experience psychological symptoms at a concerning rate but infrequently access psychological treatment. However, research in this context has been incredibly limited, and the psychological factors related to perceptions of barriers to treatment are not well understood. We set out to provide an evaluation of the perceived prevalence of common barriers to psychological care, considering how perceptions of barriers are associated with depression symptoms and coping skills. Our findings were consistent with depressive symptoms being associated with greater perceived subjective and objective barriers. Interpersonal skills demonstrated small negative associations with stigma, treatment concerns, and perceived access barriers, and mindfulness skill was negatively associated with both stigma and perceived access barriers. Emotionally impaired coping was positively related to both stigma and treatment concerns. However, behavioral and cognitive skills were not correlated with any perceived barriers. We also considered how coping skills and depression symptoms interacted to predict perceptions of barriers. We found two significant interactions for perceived access barriers specifically. When cognitive or behavioral skills were greater, psychological symptoms were more strongly related to barrier perceptions. This suggests that those with greater coping skills perceive more barriers to treatment when experiencing elevated depressive symptoms compared to those with more limited coping skills. Findings from this study provide an initial characterization of barrier perceptions among college students and have the potential to inform efforts to increase treatment seeking among college students.
This scoping review aimed to map and synthesize the contributions of Cognitive Behavioral Therapy (CBT) to culturally responsive clinical practice addressing racial and ethnic issues, with an emphasis on the mental health of Black populations. The review followed the Joanna Briggs Institute and PRISMA-ScR guidelines and included systematic searches across multiple databases and complementary sources, resulting in 22 included publications. Findings revealed a predominance of studies conducted in the United States and a notable lack of empirical research in Latin American and African contexts. Conceptual heterogeneity emerged regarding how the cultural contextualization of CBT is defined and implemented, ranging from structured adaptations of standard protocols to culturally responsive therapeutic stances integrated into case conceptualization and clinical interactions. The most frequently reported intervention domains included cognitive restructuring, coping skills training, psychoeducation, and engagement in valued activities, often accompanied by explicit validation of racism-related experiences. The literature emphasized the centrality of culturally responsive therapeutic relationships and identified structural racism and healthcare mistrust as key barriers to access and engagement. Although the field demonstrates growing methodological and clinical maturity, theoretical fragmentation and the absence of integrative conceptual models remain significant gaps, underscoring the need for further empirical research in diverse sociocultural settings.
Background Although dispositional mindfulness is inversely associated with mental health problems and suicidal ideation, the behavioral mechanisms underlying this relationship remain unclear. This study investigated whether environmental reward perception mediates this association. Method In a cross-sectional study of 407 Colombian adults, Kendall’s tau correlations and bootstrapping mediation analysis with 5,000 resamples and bias-corrected 95% confidence intervals were used to estimate indirect effects. Results Mindfulness positively correlated with reward perception; both inversely correlated with depression and suicidal ideation. The model revealed a significant indirect effect of mindfulness on depression (ab = −0.281, 95% CI [-0.335, −0.226]) and suicidal ideation (ab = −0.367, 95% CI [−0.427, −0.308]) through reward perception. Conclusions The findings were consistent with an indirect association between dispositional mindfulness and both depression and suicidal ideation through environmental reward perception. Given the cross-sectional design, these findings should be interpreted as theoretically consistent associations rather than evidence of a causal mediation process. However, these indirect associations illustrate the value of this analytic approach for identifying candidate mediators such as environmental reward perception, which can subsequently inform the design of future longitudinal and intervention research on mindfulness-based approaches to depression and suicide prevention.
Interpersonal functioning is increasingly recognized as a relevant domain in the understanding of psychological distress and relational vulnerability. The present cross-sectional study examined whether specific interpersonal styles statistically accounted for the association between interpersonal reactivity and global psychological symptomatology in a non-clinical sample. A total of 250 participants completed self-report measures assessing interpersonal reactivity (Interpersonal Reactivity Index), interpersonal problems (Inventory of Interpersonal Problems-32), and psychological symptoms (Brief Symptom Inventory-53). Two parallel multiple mediation models were tested using the Global Severity Index of the Brief Symptom Inventory. In the first model, Vindictive/Self-Centered and Socially Inhibited interpersonal styles emerged as indirect effects. In the second model, the Self-Sacrificing and Nonassertive interpersonal styles emerged as a significant indirect effects. These findings suggest that maladaptive interpersonal patterns may help clarify how interpersonal reactivity is associated with psychological distress in non-clinical populations. Overall, the study highlights the relevance of interpersonal styles in the association between interpersonal reactivity and symptom expression within an integrative framework.
Background: Menopausal symptoms, including sleep disturbances, anxiety, and mood changes often persist for years and negatively affect women's quality of life. Acceptance and Commitment Therapy (ACT) targets mental health and has demonstrated efficacy across a range of mental health conditions. Self-guided online formats may provide an accessible modality to deliver ACT-based interventions during the menopausal transition. Methods: This RCT evaluated the feasibility, acceptability, and preliminary outcomes of a 4-week self-guided online ACT program for perimenopausal and menopausal women. Forty-nine participants (M = 49.8 years) were randomly assigned to an ACT intervention or WLC. Feasibility and acceptability were the primary outcomes. Primary clinical outcomes were anxiety and depressive symptoms, while secondary outcomes included psychological flexibility and menopause-related quality of life. Analyses were conducted using both intention-totreat and per-protocol approaches. Results: Recruitment and adherence supported feasibility: 84% completed post-intervention assessments, and 48% completed all modules. Satisfaction ratings were favorable, particularly for perceived usefulness and program quality. Intention-to-treat analyses showed no significant group effects on primary clinical outcomes. However, per-protocol analyses revealed significant improvements in anxiety (partial eta 2 = 0.03) and psychological flexibility (partial eta 2 = 0.02). No significant effects were observed for depressive symptoms or quality of life. Conclusions: A brief self-guided ACT program is feasible and acceptable for midlife women, with preliminary evidence suggesting improvements in anxiety and psychological flexibility among completers. These findings support the potential role of psychological flexibility as a relevant therapeutic target in this population. Further research with larger samples is needed to confirm efficacy and optimize engagement.
Background Paediatric nurses often face high levels of burnout and occupational stress due to the emotional demands of caring for sick children. Understanding effective ways to reduce these problems is very important for their well-being and quality of patient care. Objective This systematic review and meta-analysis evaluated the effectiveness of different interventions aimed at reducing these issues. Methods Following the PRISMA 2020 guidelines, a comprehensive search was conducted across multiple databases: PubMed/MEDLINE, CINAHL, Scopus, Web of Science, PsycINFO, and ProQuest Nursing and Allied Health. Seventeen studies were included in the systematic review, of which 13 provided sufficient data for meta-analysis, involving a total of 624 participants. Data were analysed using a random-effects model, and the standardised mean difference (SMD) was calculated to measure intervention effects. Study quality was assessed using the Cochrane risk of bias tool. Results Interventions significantly reduced occupational stress among paediatric nurses [SMD = 0.437, 95 % CI (0.253–0.621), p < 0.001], with low heterogeneity. For burnout measured by the Maslach Burnout Inventory (MBI), the overall effect was small but statistically significant [SMD = 0.154, 95 % CI (0.002–0.306), p = 0.047]. Among MBI subscales, only depersonalisation showed significant improvement. When other burnout tools were used, interventions produced a moderate and significant reduction in burnout [SMD = 0.431, 95 % CI (0.166–0.697), p = 0.001]. Most studies had low to moderate risk of bias. Discussion The findings suggest that interventions, especially educational programmes and mindfulness training, are effective in reducing occupational stress in paediatric nurses. More high-quality, long-term studies are needed to develop better targeted interventions for paediatric nursing settings.
Context: In France, nearly one quarter of school-aged children experience learning difficulties, which are frequently associated with depressive and/or anxious symptoms. Objectives: This study adopts a transdiagnostic and process-oriented perspective to examine the treatment of children with specific learning disorders and associated comorbidities through a mindfulness- and relaxation-based intervention. We developed a program tailored to this population and investigated its effects on transdiagnostic processes underlying cognitive impairments and emotional difficulties. Method: This pilot uncontrolled, multi-cohort study with repeated measures, conducted over four years in a clinic specializing in specific learning disorders in France, assessing one experimental-group per year. All participants (N = 26; M age = 9, ET = 1.01) were patients at the clinic and were diagnosed with anxiety and/or depressive symptoms. To assess the preliminary effectiveness of the program, we used several cognitive, neuropsychological and psychological assessment measures at pre (T0) and post-intervention (T1) and at a follow-up 6 to 9 months after participation (T2). Results: The intervention proved to be feasible, with successful recruitment, a low dropout rate (6.7%), and high attendance at sessions. Preliminary efficacy (repeated-measures analysis of variance (ANOVA)) was reflected in a significant reduction in psychopathological symptoms (negative mood, interpersonal problems, attention difficulties) and improvements in emotional regulation, affect recognition, emotional awareness, and certain executive functions (Table 1) between T0 and T1, with these gains maintained at T2. Transdiagnostic analyses revealed strong correlations between experiential avoidance and depression/anxiety (r > 0.70), as well as a complex pattern of emotional awareness linked to both symptom expression and cognitive organization. Discussion and Conclusion: This project represents a first step in implementing the protocol within a clinical service for children with learning and attention disorders (CRTLA), with the aim of demonstrating its feasibility and supporting its deployment and further evaluation in larger-scale studies. The mindfulness and relaxation program appears to reduce depressive and anxiety symptomatology and to be a promising intervention for children with learning disabilities and associated emotional disorders, although these results should be interpreted cautiously in the absence of a control group. Key practitioner message: What is already known on the topic? Learning disorders are predominant in children in the general population and even more significant in children with ADHD, specific learning disorder or neuro-developmental disorders. center dot Mindfulness Based Interventions (MBI) and relaxation proved to have potential effects for children suffering from ADHD and other disorders, on both cognitive and emotional processes (specifically depression and anxiety). However, current treatments are limited and are usually not adapted to the cognitive difficulties faced by children (e.g., understanding oral language, knowledge of body schema). What this paper adds? The proposed program, which takes into account the language and cognitive difficulties presented by children with learning disabilities, was associated with a significant reduction in psychopathological symptoms (anxiety and depression) in children with ADHD who participated in the relaxation and mindfulness-based sessions. In addition, we observed fewer attentional difficulties after the intervention, which are predominant in ADHD and frequently present in children with learning disorders. Our results indicate that children with more functional emotion regulation skills tend to present lower levels of psychopathological symptoms. Although these findings should be interpreted with caution given the absence of a control group, they suggest that the use of this program by health and education professionals may support improvements in emotional, cognitive, and relational functioning in children with learning disabilities, both at school and at home.
Introduction Post-traumatic stress disorder (PTSD) is a worldwide, life-changing condition associated with intrusions/flashbacks, avoidance and changes in mood, cognition and arousal after experiencing a trauma. It is costly financially as well as socially and personally, and a call for an early intervention to prevent PTSD from developing is clear. Cognitive neuroscience has been drawn upon to develop the hypothesis that utilisation of a visuospatial intervention (tetris) during the early hours following a trauma, can reduce the development of intrusive memories and other PTSD-related symptoms. This has been explored in laboratory-based trials, with the field starting to expand into ‘real-world trauma’. This review systematically identified, reviewed and critically appraised literature investigating the effectiveness of tetris as an early intervention for preventing/reducing intrusive memories and other PTSD symptoms after a real-world trauma. Method PsycINFO, Medline, Scopus, CINAHL, Web of Science and ProQuest were systematically searched (final search in July 2024). Studies were subjected to a critical quality appraisal using risk of bias tools (combination/adaptation of The Critical Appraisal Skills Programme Randomised-Controlled Trial Standard Checklist and the Risk of Bias-2) and narrative synthesis. Reports were required to: use adults, use tetris as an early intervention (<72 h after trauma), use quantitative methods for measuring intrusive memories and PTSD symptoms and be real-world trauma. Findings Four studies were included (314 participants). A fifth study is reported but not included in synthesis due to being terminated. Studies had limitations such as: small sample size, differing statistical models and differing control conditions with no justifications. Overall, all studies demonstrate tetris is effective at reducing intrusive memories after one week, but there were mixed and inconclusive results for other PTSD symptoms at follow-ups ranging from one to six months. Conclusions The findings show promise at the effectiveness of tetris for reducing the initial development of intrusive memories, in line with laboratory trials. Research with larger sample sizes, more robust statistical approaches, better utilisation of control groups and a more in-depth look at any trauma-specific effect are needed before this low-cost, ‘therapist-free’ intervention could be implemented. Other This review was registered on Prospero (CRD42024555956).
This study aimed to provide a novel analysis of the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) within a diverse Colombian population, also extending its validation across more diverse populations and enhancing the generalizability of the findings. The AAQ-II is widely used to measure Psychological Inflexibility (PI), which is composed of seven items on a Likert scale. The participants were 4379 Colombian males and females. The analysis of the internal structure, quality of items, and measurement invariance (MI) of the AAQ-II was performed using a Graded Response Model (GRM). Results confirmed the unidimensional structure, which explained 71% of the variance, and showed strong factor loadings ranging from 0.80 to 0.88 across the seven AAQ-II items. The item analysis showed good values of discrimination and difficulties across the seven options of the answer of the Likert scale, suggesting that the AAQ-II effectively measures different levels of PI. The test information function (TIF) indicated that the AAQ-II provides a reliable measure for individuals with average and high PI scores. The MI results showed that there is invariance between males and females. The AAQ-II demonstrated adequate psychometric properties, including a well-defined unidimensional structure, high item discrimination, satisfactory measurement precision for average-to-above-average PI levels, and measurement invariance across gender, providing solid evidence of validity to support the interpretation of its scores.
This study examines the relationships between doomscrolling, stress, emotional distress, and anhedonia in women aged 20-59 years. Guided by negativity bias theory, which explains individual's predisposition to focus on negative stimuli, the research explores how doomscrolling perpetuates psychological distress and disrupts emotional well-being. A cross-sectional survey design was employed with 105 women completing validated measures, including the Doomscrolling Scale (DSS-15), Perceived Stress Scale (PSS-4), Depression Anxiety Stress Scale (DASS-10), and Snaith-Hamilton Pleasure Scale (SHAPS-14). Correlation analyses revealed significant positive relationships between doomscrolling, stress, and emotional distress, while regression analysis identified doomscrolling and stress as significant predictors of anhedonia. Doomscrolling emerged as the strongest predictor, while emotional distress showed a weaker, non-significant contribution. These findings align with negativity bias theory, suggesting that repeated exposure to negative stimuli amplifies stress, depletes emotional resources, and fosters maladaptive behaviors. The study underscores the need for targeted interventions, such as mindfulness strategies, resilience training and digital literacy programs, to mitigate the adverse effects of doomscrolling. Limitations include the cross-sectional design, reliance on self-report measures, and focus on women aged 20-59. Future research should adopt longitudinal approaches, investigate additional variables such as coping mechanisms and cultural influences, and include diverse populations to better address the mental health impacts of doomscrolling.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-established treatment for chronic insomnia, but its effectiveness varies widely, particularly among shift workers who face irregular sleep-wake schedules and elevated stress levels. In this single-arm open trial, we investigated heterogeneous response patterns to CBT-I and their predictors in a cohort of 50 shift-working firefighters (mean age 34.8 +/- 7.7 years; 88% male) who completed a five-week intervention. The primary outcomes were the Insomnia Severity Index and sleep diary-based measures, including sleep onset latency, total sleep time, and self-reported sleep quality. Sleep quality was assessed longitudinally, and growth mixture modeling was used to identify latent trajectories of treatment response. Three distinct response patterns were identified: steady-poor (24%), steady-moderate (50%), and improving (26%). This classification, based on subjective reports, was further examined using a mathematical model of alertness that is widely used in sleep and circadian research. The model was applied to wearable data to derive physiological response patterns. Multinomial logistic regression revealed that poor response was associated with engagement in emergency duty, longer sleep onset latency, and higher insomnia severity, while improved response was associated with shorter shift work duration, lower alcohol intake, and a 3-day shift cycle. These findings highlight that sleep quality trajectories during the intervention are highly heterogeneous and are associated with both clinical and occupational factors, suggesting that tailored intervention strategies may be needed to enhance treatment effectiveness in high-risk occupational groups.
Rising burnout levels demand scalable solutions, yet trials comparing mobile health solutions remain scarce. This randomized controlled trial assessed the efficacy and underlying mechanisms of two self-guided applications: PsyPills (TM) and ACT Companion (TM) against a waitlist control condition. A sample of 113 participants was randomized into three groups. The digital interventions were self-administered over six weeks. Primary outcome measures included changes in burnout levels from baseline to post-treatment. Data analyses included repeated-measures ANOVAs with Bonferroni-corrected post-hoc comparisons, ANCOVAs adjusting for baseline scores, and regression-based bootstrapped mediation analyses using change scores. Attrition was high, with 64 participants included in the final analyses (56.6% retention); dropout was non-systematic. Both intervention groups showed significant reductions across all burnout dimensions compared to the control group. The REBT intervention demonstrated significantly greater reductions than the ACT intervention for emotional exhaustion (d = 2.53), depersonalization (d = 2.89), and reduced personal accomplishment (d = 2.53) (all p < 0.001). Although significant changes were observed in rational and irrational beliefs, mediation analyses did not support rational and irrational beliefs, psychological flexibility, or emotion regulation as significant mechanisms underlying burnout reduction. Although the interventions demonstrated significant effects, the study leaves several important questions unanswered. Most notably, the mechanisms through which burnout reductions occurred remain unclear. Given the study's limited sample size, high attrition rate, and short follow-up period, these findings should be interpreted cautiously and warrant further investigation before firm conclusions can be drawn. Nevertheless, the present findings provide preliminary evidence that digital CBT-based interventions may represent a promising approach to reducing burnout symptoms.
This study examined Argentine psychotherapists' self-reported influences on theoretical orientation, sources of clinical information, and attitudes toward research evidence, the scientific method, and evidence-based practice. A total of 284 therapists completed an online survey, of whom 261 were retained for analysis after exclusions. Data were analysed using ANCOVAs, multinomial logistic regression, and cluster analyses. Across the full sample, therapists reported relying primarily on books, supervision, and clinical experience to inform their practice, whereas scientific literature and outcome measures were among the least consulted sources. Attitudes toward the scientific method and the reported use of research-informed sources varied systematically across theoretical orientations. Therapists identifying with cognitive-behavioural approaches showed greater alignment with research-informed practices than those identifying with other orientations, and these attitudes were also associated with age and weekly working hours. Cluster analyses identified four attitudinal profiles that captured this variability. Overall, the results suggest that, within this sample, research evidence played a limited role in therapists' reported clinical decision-making, with relevant variation linked to both theoretical orientation and career stage. Future studies should examine how training experiences shape engagement with research evidence across the diverse traditions that coexist in Argentine psychotherapy.
